Patient Forms

Oh My! So Many Forms!

Currently we are supposed to be living in a “paperless office” era. One must keep a good sense of humor about these things. 🙂 However, it is quite ironic that there remain so many paper forms. We need to gather information regularly and these forms help us to provide the best care, to communicate effectively, and to bill accurately. Your help is essential in this area. The different forms are listed below for your convenience. We hope to, in the near future, have all the required forms available online which will streamline the process.

Patient Information Handbook

In the waiting room and examination rooms, you will find a binder labeled “Patient Information Handbook“. In this binder, you can view important information about our office, our philosophy, and our policies, along with important ongoing health care information. All the documents in these binders can be accessed below.

Beginning in 2013, we will be transitioning to making all our forms available online. This will allow you to complete the forms at home at your own pace. The forms will be HIPAA compliant if you follow the methods outlined below.

Please download the latest version of Acrobat Reader (http://get.adobe.com/reader)

Acquisition of General Information

As you may have noticed, you are required to complete the Phreesia pads at each and every visit. This is how we collect demographic, emergency, insurance, and financial information on all families, old and new. You will need to update any changes, but also inform the staff of changes, so that we can update your electronic chart.

Well Child Visit Forms and Documents

Yes we ask lots of questions during a well child visit. Our goal is to have these forms available online so that you may fill them in prior to the visit, thereby decreasing the visit time. Approximately two weeks prior to your child’s well visit, we will email you a reminder and a link to the online forms so that you may securely log in and complete the forms at home.

If your child is 6 months old or younger for their well visit, there will be a form to fill out about your baby’s daily habits, nutrition, stools, and sleep.

Health Forms for Daycare, School, Sports, and Camps

It is your responsibility to complete your portion of any of these forms prior to the visit. These various forms will not be completed until the child is up-to-date on their well child visits.

Below is a link to the most common forms we use in the office. Print out and complete your part of the form, then bring into the office at the time of your visit. Please allow 3 days for form completion and there will be a $5 charge for each signature. Alternatively you may get the form the next day for $10 or immediately for $15.

If your child is 4 years old or older and it has been more than 6 months, but less than 12 months since the last well child visit, then you must also complete the Interim Health Assessment Form to document any or no significant change in the health status since their last visit.

Office Hours

Patient Education Materials

Your browser does not support frames or is currently configured not to display frames. However, you may visit the From Your Doctor Website for doctor recommended health information and health resources, powered by Vivacare.